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Revised Criteria for Diagnosis of Alzheimer’s Disease (AD)

The National Institute on Aging and the Alzheimer’s Association (NIA-AA) charged a workgroup with the task of developing criteria for the symptomatic predementia phase of Alzheimer’s disease (AD), referred to in this article as mild cognitive impairment due to AD.

Probable AD dementia is a syndrome of dementia defined by the following characteristics:

Interference with ability to function at work or at usual activities

A decline from a previous level of functioning and performing

Not explained by delirium or major psychiatric disorder

Cognitive impairment established by history-taking from the patient and a knowledgeable informant; and objective bedside mental status examination or neuropsychologic testing

Cognitive impairment involving a minimum of two of the following domains:

Impaired ability to acquire and remember new information

Impaired reasoning and handing of complex tasks, poor judgment

Impaired visuospatial abilities

Impaired language functions

Changes in personality, behavior or comportment

Other core clinical criteria include:

Insidious onset

Clear-cut history of worsening

Initial and most prominent cognitive deficits are one of the following:

Nonamnestic presentations include either a language presentation, with prominent word-finding deficits; a visuospatial presentation, with visual cognitive deficits; or a dysexecutive presentation, with prominent impairment of reasoning, judgment and/or problem solving

No evidence of substantial concomitant cerebrovascular disease, core features of dementia with Lewy bodies (DLB), prominent features of behavioral variant frontotemporal dementia or prominent features of semantic or nonfluent/agrammatic variants of primary progressive aphasia, or evidence of another concurrent, active neurologic or non-neurologic disease or use of medication that could have a substantial effect on cognition.

Possible AD includes either of the following clinical scenarios:

Atypical course: The core clinical criteria above are met in terms of the nature of the cognitive deficits, but there is either a sudden onset of cognitive impairment or insufficient historical detail or objective documentation of progressive decline.

Etiologically mixed presentation: All of the core clinical criteria for AD dementia are met but the individual also has evidence of concomitant cerebrovascular disease, features of DLB other than the dementia itself, or evidence for another neurologic or medical comorbidity or medication that could have a substantial effect on cognition.